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General NPI Number Information
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NPI Number | 1730464090
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Entity Type | Organization
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Legal Business Name | ELIZABETH S. MADDAFORD,LCSW,PLLC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 602 STRADA CIR STE 110
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City | MANSFIELD
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State | TX
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Zip | 76063-3201
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Country | US
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Telephone | 817-842-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SILVER ROSE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-2886
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Country | US
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Telephone | 181-769-0842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH MADDAFORD
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Credential | LCSW
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Telephone | 817-842-9081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 29770
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License Number State | TX
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